NSG 203 PP ENDOCRINE

After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine, 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

Primary hypothyroidism

A client's glucose level is 365 mg/dL. The health care provider orders 10 units of regular insulin to be administered. The bottle of regular insulin is labeled 100 units/mL. How many milliliters of insulin should the nurse administer? Record your answer using one decimal place.

0.1

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl/3 mmol/L, (2.3 mmol/L) and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

10 to 15 g of a simple carbohydrate.

A client who is diagnosed with hyperthyroidism is admitted to the hospital. The nurse anticipates that the client's treatment is most likely to include which medication?

A thyroid hormone antagonist

The nurse is caring for a child with type 1 diabetes. The child reports feeling shaky, and the nurse observes the child to be pale and sweaty. Which action should be taken?

Give the child a glucose tablet to eat.

Observation of a client reveals thin extremities, but an obese truncal area and a "buffalo hump" at the shoulder area with reports of weakness and disturbed sleep. The nurse interprets this data as indicating which disorder?

Cushing syndrome

The nurse is caring for a client who vomits 1 hour after taking a morning glyburide. What is the priority nursing action?

Monitor blood glucose closely and look for signs of hypoglycemia.

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The client becomes confused and develops crackles and dyspnea. What is the priority action of the nurse?

Notify the health care provider.

A client with primary diabetes insipidus is prescribed desmopressin. Which instruction should the nurse provide before the client is discharged?

"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

When children are more physically active, which change in the management of the child with diabetes should the nurse expect?

increased food intake

A 78-year-old client with type 2 diabetes needs a kidney transplant. The client's daughter volunteers to donate a kidney, but the client voices concerns about her daughter's health to the nurse. Which response by the nurse is appropriate?

"I'll notify your physician of your concerns and see if he can discuss the procedures with you."

The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and:

vitamin D.

The nurse is caring for a patient with diabetes who is lethargic and has developed rapid, deep respirations. Which action should the nurse take?

Assess glucose level.

The client with Addison's disease is admitted to a medical-surgical unit. The nurse educator is discussing with the student why this client at risk for development of hypoglycemia and asks the following question: "The decreased adrenal cortical function of which substances leads to decreased glucose availability?"

Glucocorticoids

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse is preparing to draw laboratory values. Which laboratory test should the nurse perform?

Glycosylated hemoglobin level

Which instructions should be included in the discharge teaching plan for a client after a thyroidectomy for Graves' disease?

Have regular follow-up care

In caring for a client with insulin-dependent diabetes mellitus, the nurse identifies that the client may require which change to their daily routine during periods of infection?

more insulin

A client with type 2 diabetes comes to the clinic with a diabetic foot ulcer on his left heel that hasn't responded to treatment. Which action should a nurse take after assessing the ulcer?

Suggest a consult with a wound care specialist

While reinforcing education with the parents of a child of short stature, the nurse discusses familial short stature. Which statement by the nurse about this condition is most accurate?

"It occurs in children who have ancestors with adult height in the lower percentiles and whose height during childhood is appropriate."

An older child has received diet instruction as part of the treatment plan for type 1 diabetes. Which statement by the older child indicates to the nurse the need for additional instruction?

"I can eat whatever I want as long as I cover the calories with sufficient insulin."

The nurse and a client have just discussed the client's recent diagnosis of hypothyroidism and its causes and effects. Which statement indicates that the client needs further instruction?

"I just eat too much. That's why I'm depressed and overweight"

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse would be most accurate in stating:

"It tells us about your sugar control for the last 3 months."

When reinforcing education with the parents about signs that indicate levothyroxine overdose, which comment by a parent indicates the need for further education?

"I shouldn't worry if my baby doesn't sleep very much."

Which statement made by a parent of a child with short stature would indicate to the nurse the need for further education?

"Obtaining blood studies won't aid in proper diagnosis."

The nurse explains the causes of hypothyroidism to the parents of a newly diagnosed infant. The nurse recognizes that further education is needed when the parents ask which question? Select all that apply.

"So, this is a condition that will always require thyroid replacement therapy for life?" "So, hypothyroidism can be treated by exposing our baby to a special light, right?"

The parents of a child diagnosed with diabetes ask the nurse about maintaining metabolic control during a minor illness with loss of appetite. Which nursing response is appropriate?

"Substitute calorie-containing liquids for uneaten solid food."

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

"You must avoid coughing, sneezing, and blowing your nose."

A client reports muscle weakness, anorexia, and darkening of the skin. The nurse reviews laboratory data and notes findings of low serum sodium and high serum potassium levels. The nurse recognizes these signs and symptoms as associated with which condition?

Addison's disease

A client with long-standing type 1 diabetes is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should help formulate a nursing diagnosis of:

Deficient knowledge.

A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. The client's wife reports that she noticed that he acted confused and was extremely weak when he woke up in the morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. Which of the following would the nurse expect to administer by I.V. infusion?

Hydrocortisone

During a physical assessment, the nurses notices the client has a Chvostek's sign when she tapped over the client's facial nerve. The nurse reviews the client's laboratory vales and expects to find which electrolyte imbalance?

Hypocalcemia

The newly diagnosed diabetes mellitus client is to receive his first insulin dose. The nurse administers the insulin into his abdomen. How does absorption at the abdominal site compare to absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan?

Maintain a moderate exercise program.

When administering spironolactone to a client who has had a unilateral adrenalectomy, the nurse should instruct the client about which possible adverse effect of the drug?

Menstrual irregularities

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting fluids

A diabetic client develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect may these findings have on his need for insulin?

They will increase the need for insulin.

During preoperative teaching for a client who will undergo a subtotal thyroidectomy, the nurse should include which statement?

You must avoid hyperextending your neck after surgery."

A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. A student nurse asks what is this disorder caused by. The nurse would respond that "Cushing's syndrome is most likely caused by:

a corticotropin-secreting pituitary adenoma.

When caring for a client with hypothyroidism, the nurse monitors the client for which potentially serious complication?

cardiac dysrhythmia

The nurse is caring for a client with possible Cushing's syndrome undergoing diagnostic testing. The health care provider orders lab work and a dexamethasone suppression test. Which parameter is measured with the dexamethasone suppression test?

cortisol levels before and after the system is challenged with a synthetic steroid

A client experiences polydipsia and voiding large amounts of waterlike urine with a specific gravity of 1.003. What do these clinical manifestations indicate to the nurse?

diabetes insipidus

A nurse is gathering data from a child with juvenile hypothyroidism. Which common clinical finding would most likely be observed?

dry skin

Which condition could possibly cause hypoglycemia?

excessive exercise without a carbohydrate snack

A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these findings, the nurse would suspect:

hyperparathyroidism.

A client with Cushing syndrome is experiencing sodium and water retention. For which disorders will the nurse monitor the client?

hypertension and heart failure

A client with diabetes mellitus has just been prescribed insulin. When teaching the client about hypoglycemia, the nurse should mention that this reaction may cause:

nervousness, diaphoresis, and confusion.

A client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? Select all that apply.

numbness tingling muscle twitching and spasms

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:

phosphorus.

The nurse is reinforcing education with a client who has hypothyroidism about the thyroid gland. Which statement by the nurse would be most accurate about which gland controls the secretion of thyroid hormone?

pituitary gland

The nurse is caring for a client suspected of experiencing hyperglycemia. Which symptoms would correlate with this suspicion?

polydipsia, polyuria, and polyphagia

The nurse is assigned to care for a postoperative client who has diabetes mellitus. During data collection, the client reports that he's impotent and says he's concerned about its effect on his marriage. In planning this client's care, the most appropriate intervention would be to:

suggest referral to a sex counselor or other appropriate professional.

A nurse is evaluating a client with hyperthyroidism. Which findings should the nurse anticipate that correlate with the diagnosis?

weight loss, nervousness, and tachycardia

A nurse is caring for a client with newly diagnosed diabetes mellitus. Which information should the nurse reinforce in education sessions about dietary management of diabetes?

"Meals should be eaten at consistent times each day."

The nurse is to administer the morning dose of NPH insulin to a client with type 1 diabetes. The client is alert and oriented; before administering the medication, the nurse obtains a glucose reading of 52. What should the nurse do at this time?

Give the client breakfast and then recheck the glucose level.

The parents of a child who's going through testing for hypopituitarism ask the nurse what test results they should expect. The nurse's response should be based on which factor?

Growth hormone levels are elevated 45 to 90 minutes following the onset of sleep.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. The client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia

A client with a diagnosis of diabetes insipidus is being treated with desmopressin acetate. The client asks, "What is this medication?" What is the best response by the nurse?

a synthetic vasopressin

A nurse is reviewing data in the progress notes entry of a client with adrenocortical insufficiency (Addison's disease). The client reports difficulties in the work environment and a recent upper respiratory infection. The nurse identifies the client as at risk for which condition?

adrenal crisis

The nurse is reviewing the laboratory values for a client with diabetes mellitus. Which value should the nurse notify the health care provider about? Select all that apply.

blood glucose 70 mg/dL serum sodium 130 mEq/L

A nurse reviewing the laboratory results on a client's chart notes findings of increased serum phosphate levels and decreased serum calcium levels. These findings indicate which condition?

hypoparathyroidism

A nurse is collecting data on a child with growth hormone deficiency. Which characteristic would the nurse most commonly observe?

increased weight with decreased height